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Why Your Antibiotics Don’t Work

Did you get hit with the flu this season? If so, you had plenty of company, as the Centers for Disease Control and Prevention (CDC) peg this year’s United States outbreak as the most widespread since the H1N1 pandemic in 2009. That’s partially because this season’s flu vaccine seemed less effective at preventing the disease than usual, giving most inoculated individuals only a 56% lower chance of needing further treatment, while benefiting an even more dismal 27% of those aged 65 and older. It’s somewhat unknown at the moment why the vaccine couldn’t find its stride, but we have a much better understanding of why diseases like strep throat and Staph infections become more and more difficult to combat over time. And you might be part of the problem.

If you were unfortunate enough to come down with a bad case of influenza, did your doctor prescribe a little bit of Cipro or Amoxil? He shouldn’t have. Such antibiotic remedies are only useful against bacterial infections and can’t do a thing to strike at cold and flu viruses. Why do they get wrongfully doled out? Some doctors do so to ward off opportunistic bugs that try to move in while the immune system is weakened. Others feel the need to give sufferers something, even if it’s not effective. Many patients don’t understand the limitations and won’t leave until they’ve got a scrip in their hand, or they’ll take their business to a doctor who will do what they want, even if that’s in opposition to what they really need. The CDC estimates that almost 60% of all antibiotic prescriptions in the years 2007 and 2008 were incorrectly applied to viral infections, although reports indicate that statistic has been cut by as much as a quarter since.

image courtesy of nextnature.net

So what? What’s the harm? Doctors get to feel like they did something helpful, drug companies make a few more bones and patients receive peace of mind, even if it’s illusory. The problem with over-prescribing antibiotics is a product of the same process that got us these big brains we use to develop them. Whenever you drop that antibacterial hammer on a population, inevitably there will be some individual organisms that were lucky enough to have a natural resistance to the chosen treatment. Those are the ones that survive to make more just like them. The ill-adapted get whacked, the “stronger” survive and multiply and pretty soon you’ve got a new strain of bugs that brushes off your old drugs like a case of dandruff. That’s selection in action; Darwinian evolution on display. We wouldn’t be here without it, yet it’s also what drives some of our worst diseases. Now half of U.S. Staph infections are resistant to our most common antibiotics and a strain of enterobacteriaceae has proven nearly immune to even the toughest remedies, leading to a 40% mortality rate in those infected.

WHAT DOES THIS MEAN?

You shouldn’t press your doctor for antibiotic treatment unless he’s sure it’ll be genuinely helpful. Conversely, if you’re diagnosed with a viral infection and a physician tries to prescribe you antibiotics anyway, question him if that’s the wisest course of action. He might just be trying to avoid and argument. And when you do find yourself on a regimen, be sure to see the entire course through, as ending early can bolster the remaining bacteria, creating a relapse for yourself and a dangerous new adversary for the rest of us.

Study results are mixed as to whether wildly common antibacterial handsoaps contribute to microbial resistance and if they’re actually any more effective than their garden variety counterparts. It seems that triclosan, the most common active agent in antibacterial soaps, needs to remain on a surface for as long as two minutes to do its job. Does anyone actually do that? When you also consider that new research suggests the very same chemical may weaken muscle contraction and alter hormone regulation, it’s probably not the worst idea to just stick to the old standbys instead.

Antibiotics are overused on animals as well. The Union of Concerned Scientists has estimated that 70% of of the drugs in America are administered to food animals in the absence of any disease, as a means of promoting growth. After 35 years of trying to pass similar bills, legislation was finally pushed through in 2012 that requires farmers and ranchers to obtain a prescription from a veterinarian to use antibiotics on farm animals, but what if the vets aren’t any more judicious than our clinicians? Constant vigilance on the part of the entire medical community and the citizenry itself will be required to check the further emergence of resistant strains.

4 Comments.

Nice article. Of course,it’s not just the western world that is contributing to the problem. People in countries like India are known to buy 1 or 2 tablets of antibiotics, not from doctors. This is not enough to kill off the infection so it just makes things worse. I think generally people are not educated well enough about what antibiotics can and can’t do.

Antibiotics are seen as something that “works.” People don’t realise that resistance can be developed so quickly. I think there are only a couple of antibiotics left that work on Gonnorhea. Part of the issue is that all the “easy wins” in Antibiotics have been done. Many antibiotics are just modifications of previous antibiotics.

Penicillin works because it contains something called a “β Lactam ring”. There are a lot (probably over 30) types of antibiotics that work by using the β Lactam ring. The ring sticks to specific proteins on the outside “cell wall” of bacteria. When the Bacteria tries to multiply the antibiotic stops it making new cell walls. As such the bacteria cannot multiply to create new bacteria, and it is also easier for your body to deal with.

The problem is that because so many drugs work the same way, a mutation that stops 1 antibiotic stops most of them. Bacteria have 2 tricks against the β Lactam ring: They make enzymes that destroy the ring and make it useless or they change their proteins so that the antibiotic cannot get into the right place to do it’s job.

Interesting read, which is also useful to me and I expect many others. I was unaware of the extent to which doctors might hand out antibiotics when they aren’t necessary, or the ineffiency of antibacterial handsoaps.

On a point of pedantry I think the dcotor references should say he/she.